Migliaccio S,Greco EA,Fornari R, Donini LM, Di Luigi L,Lenzi A.
Skeletal alterations in women affected by obesity.
Aging Clinical and Experimental Research. 2013
Abstract
Obesity has always been considered a protective factor for the skeleton and for osteoporosis. However, new epidemiologic and clinical data have shown that high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Further, increasing evidences seem to indicate that the different components of metabolic syndrome (i.e. hypertension, increased triglycerides, and reduced high-density lipoprotein cholesterol) are also potential risk factors for the development of low bone mineral density and osteoporosis.
Migliaccio S,Fornari R, Greco EA, Di Luigi L,Lenzi A.
New therapeutical horizons in the management of postmenopausal osteoporosis
Aging Clinical and Experimental Research2013
Abstract
Osteoporosis is a bone metabolic disease characterized by a compromised skeletal fragility, leading to an increased risk of developing spontaneous and traumatic fractures. This disease is the consequence of an imbalance of the physiological process of bone turnover (or coupling), with the lost of the equilibrium between the activity of osteoblasts and osteoclasts. Therapy has been aimed mainly at the correction of the imbalance between bone resorption and bone formation, to protect skeletal integrity and reduce the risk of fractures. Thus, pharmacological treatments have been aimed at modulating the activity of bone cells.
Trevisan C, Klumpp R, Nava V, Riccardi D, Recalcati W
Surgical versus conservative treatment of distal radius fractures in elderly
Aging Clinical and Experimental Research 2013
Abstract
The distal radius fractures (DRFs) are the second most common fracture in the elderly population. Despite their frequency, the optimal treatment of these fractures remains controversial. Several dogmatic myths on DRFs management may adversely affect their outcome and despite a strong trend versus surgical options, systematic reviews suggest that conservative treatment remains the safest option for DRFs in most cases.
Cadossi M, Mazzotti A, Capra C, Persiani V,Luciani D, Pungetti C
Proximal humeral fractures in elderly patients
Aging Clinical and Experimental Research 2013
Abstract
Proximal humeral fractures are common in the setting of osteoporosis and they represent a problem not only for increased mortality risk factors, but also in terms of costs and management. Their increased incidence has resulted in an evolution of treatment options, but currently there is no scientific evidence that defines the best treatment to choose. The choice of treatment depends on a variety of factors, such as fracture dislocation, fracture classification, bone quality, patient’s age, functional requirements and general medical conditions. The debate about the treatment is still open, both for the decision between surgical and conservative treatment, and between different types of surgical techniques; nowadays it remains unclear whether surgery will produce better outcomes in function and quality of life in elderly osteoporotic patients.
Ratti C, Vulcano E, Canton G, Marano M, Murena L,Cherubino P
Factors affecting bone strength other than osteoporosis
Aging Clinical and Experimental Research 2013
Abstract
Osteoporosis is the most common cause of bone fragility, especially in post-menopausal women. Bone strength may be compromised by several other medical conditions and medications, which must be ruled out in the clinical management of patients affected by fragility fractures. Indeed, 20–30 % of women and up to 50 % of men affected by bone fragility are diagnosed with other conditions affecting bone strength other than osteoporosis. These conditions include disorders of bone homeostasis, impaired bone remodeling, collagen disorders, and medications qualitatively and quantitatively affecting bone strength. Proper diagnosis allows correct treatment to prevent the occurrence of fragility fractures.
Iolascon G, Cisari C, Moretti A, Frizzi L, Gimigliano R, Gimigliano F
NSAIDs and opioids in management of fragility fractures
Aging Clinical and Experimental Research2013
Abstract
Fragility fractures and their care are a major burden on individuals, health systems, and social care systems in industrialized countries. Fragility fracture can lead to long lasting painful and disabling condition. The level of pain is a major determinant for the outcome of any treatment of these fractures regardless of its location. The treatment of pain in patient with fragility fracture is rarely considered a priority in the care pathway.
Raymond Klumpp, Carlo Trevisan, Veronica Nava, Domenico Riccardi, Wilmer Recalcati
Considerations on evolution and healing of vertebral fractures
Aging Clinical and Experimental Research 2013
Abstract
Only little is known when talking about the evolution of a vertebral fracture. From the few studies available in the literature, we can deduce that the risk a vertebral compression fracture has to worsen its deformity is consistent. It is important to try to make a prognosis on how the fracture is going to heal based on the type of fracture encountered. A chapter of its own is the occurrence of a vertebral fracture non-union that is difficult to diagnose and treat, but comes along with a poor prognosis.
Riccardo Iundusi, Alessandro Scialdoni, Mario Arduini, Daniela Battisti, Alessandro Piperno, Elena Gasbarra, Umberto Tarantino
Stress fractures in the elderly: different pathogenetic features compared with young patients
Aging Clinical and Experimental Research2013
Abstract
Stress fractures mainly occur in the lower limb as a result of cyclic submaximal stresses. Most commonly affected by this specific type of fractures are young athletes, military or elderly subjects with metabolic bone diseases like osteoporosis. In consideration of the heterogeneity of affected patients is presumable that there are different pathogenic mechanisms. In young person bone tissue, although metabolically intact, is not able to withstand the stresses to which it is chronically subjected, also because of muscle fatigue. This leads to a macrostructural failure and to the development of “fatigue” fractures. Instead, in elderly patients, there are numerous physiological conditions that determine a bone metabolism alteration. This is the main reason for the structural changes in trabecular and cortical bone, which is reflected in reduced biomechanical strength. In addition, muscular situation, such as muscle fiber atrophy, is unable to correctly support bone tissue, leading to the development of insufficiency fractures.
Irene Cerocchi, Stefano Ghera, Elena Gasbarra, Maurizio Feola, Umberto Tarantino
The clinical significance of wrist fracture in osteoporosis
Aging Clinical and Experimental Research2013
Abstract
Wrist fracture is the most common fragility fracture in perimenopausal and young postmenopausal women in USA and Northern Europe. Recent studies based on high-resolution imaging have shown microarchitectural deterioration of trabecular bone even in premenopausal women presenting with a wrist fracture. These fractures increase the risk of subsequent fractures, especially in the first 7 years. So, wrist fracture female patients must be appropriately screened and treated for osteoporosis in order to preserve bone quality and prevent future, more severe, fractures.
G. Piarulli, A. Rossi, G. Zatti
Osseointegration in the elderly
Aging Clinical and Experimental Research 2013
Abstract
Osseointegration is a term that refers to the formation of a direct interface between an implant and bone without intervening soft tissue. Cementless femoral fixation in total hip arthroplasty is dependent on mechanical and biological factors that affect implant stability and long-term outcome. Osteoporosis leads to morphological and biological alterations in the proximal femur that adversely affect both mechanical stability of implant and biological response of bone, making it more challenging to achieve a valid osseointegration.
Irene Cerocchi, Stefano Ghera, Elena Gasbarra, Alessandro Scialdoni, Umberto Tarantino
Fragility fractures: the clinical pathway
Aging Clinical and Experimental Research2013
Abstract
The clinical management of fragility fracture is simple but complex at the same time. Patients are different from one another, and advancing age increases the prevalence of comorbidities and conditions that can impair bone quality and healing, while increasing the risk of falls and fractures. Keeping in mind some principles and key points can help identify patients at risk, thus following an ideal path for the identification, treatment and prevention of fragility fractures.
Chiara Ratti, Ettore Vulcano, Giuseppe La Barbera, Gianluca Canton, Luigi Murena, Paolo Cherubino
The incidence of fragility fractures in Italy
Aging Clinical and Experimental Research 2013
Abstract
Osteoporosis can significantly impact on the risk of developing a fracture. Thus, fragility fractures represent a challenge for health professionals and decision makers of the twenty-first century. The aim of this work is to review the literature concerning osteoporotic fractures in Italy in terms of incidence, rate of hospitalization, relative risk of a new fragility fracture, and costs for the national health system. It was estimated that the costs of treating proximal femur fragility fractures in 2002 summed up to 1 billion Euros. The number of fragility fractures in Italy was calculated as follows: 91.494 hip fractures, 61.009 clinical vertebral fractures, 57.401 humeral fragility fractures, and 94.045 forearm/wrist fragility fractures. The incidence of fragility fractures in Italy is very high, and osteoporosis is the leading cause of morbidity in the Italian population.
Elena Gasbarra, Fabio Luigi Perrone, Monica Celi, Cecilia Rao, Maurizio Feola, Nicola Cuozzo, Umberto Tarantino
Total hip arthroplasty revision in elderly patients
Aging Clinical and Experimental Research 2013
Abstract
In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality.
Sandro Giannini, Eugenio Chiarello, Valentina Persiani, Deianira Luciani, Matteo Cadossi, Giuseppe Tedesco
Ankle fractures in elderly patients
Aging Clinical and Experimental Research 2013
Abstract
The incidence of ankle fractures (AFs) in the elderly is rising due to the increase in life expectancy. Rather than directly related to osteoporosis, AFs are a predictor of osteoporotic fractures in other sites. In women AFs are associated with weight and BMI. AFs are difficult to categorize; therapeutic options are non-operative treatment with plaster casts or surgical treatment with Kirschner’s wires, plates and screws. The choice of treatment should be based not only on the fracture type but also on the local and general comorbidity of the patient. Considering the new evidence that postmenopausal women with AFs have disrupted microarchitecture and decreased stiffness of the bone compared with women with no fracture history, in our opinion low-trauma AFs should be considered in a similar way to the other classical osteoporotic fractures.
Monica Celi, Cecilia Rao, Alessandro Scialdoni, Valerio Tempesta, Elena Gasbarra, Pietro Pistillo, Umberto Tarantino
Bone mineral density evaluation in osteoporosis: why yes and why not?
Aging Clinical and Experimental Research 2013
Abstract
Osteoporosis is a diffuse skeletal disease in which a decrease in bone strength leads to an increased risk of fractures. A wide variety of types of bone densitometry measurements are available, including quantitative computed tomography measurements of the spine, quantitative ultrasound devices for measurements of the heel and other peripheral sites and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD) at the lumbar spine, proximal femur, forearm and total body scans. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. However, in recent years, the authors have raised some important questions about the objective limits of this method that have led to doubts about its effectiveness in terms of clinical outcome.
G. Marongiu, M. Mastio, A. Capone
Current options to surgical treatment in osteoporotic fractures
Aging Clinical and Experimental Research 2013
Abstract
Treatment of osteoporotic fractures leads to significant challenges for the surgeon, including poor implant fixation related to low bone quality and compromised capacity of fracture healing. This article reviews the osteosynthesis and arthroplasty results in the surgical treatment of proximal femur, proximal humerus and wrist fractures to define the current options to decrease failure in fragility fracture management.
I. Riccio, A. Tirelli, F. Gimigliano, G. Iolascon, R. Gimigliano
Rehabilitative approach in patients with vertebral fragility fracture
Aging Clinical and Experimental Research 2013
Abstract
Osteoporosis is a skeleton disease characterized by low bone mineral density and deterioration of bone tissue, resulting in an increased risk of fragility fracture. Osteoporotic vertebral fractures are recognized as a significant health problem particularly in older people with an impact on the quality of life, mobility and mortality. A well-timed diagnosis and treatment is necessary in preventing further vertebral fracture and their consequences. Exercise alone or as part of physical therapy management is often recommended as a non-pharmacological intervention. The exercise protocols, designed specifically for individuals with vertebral fracture, should include postural correction, trunk and lower extremity muscle strengthening, balance exercises and falls prevention program. The aim of this short communication is to examine the rationale of a rehabilitation protocol after a vertebral fracture
G. Manenti, S. Capuani, Armando Fusco, E. Fanucci, U. Tarantino, G. Simonetti
Osteoporosis detection by 3T diffusion tensor imaging and MRI spectroscopy in women older than 60 years
Aging Clinical and Experimental Research 2013
Abstract
Aim of this study was to evaluate the cancellous bone quality of postmenopausal women (age >60 years) by diffusion tensor imaging (DTI) using mean diffusivity (MD) and fractional anisotropy (FA) in combination with proton magnetic resonance spectroscopy (1H-MRS). 20 postmenopausal women older than 60 years were introduced to dual-energy X-ray absorptiometry (DXA) examination in femoral neck and to an MRI spectroscopy and DTI evaluation at 3T. We observed that fat fraction (FF) can discriminate healthy and osteoporotic patients. Water mean diffusivity (MD) and FA can discriminate the healthy group from osteopenic and osteoporotic group. MD/FF vs FA/FF graph extracted from the femoral neck identifies all healthy individuals, according to DXA results. DTI and spectroscopy protocol performed in the femoral neck could be highly sensitive and specific in identifying healthy subjects.
Umberto Tarantino, Jacopo Baldi, Monica Celi, Cecilia Rao, Federico Maria Liuni, Riccardo Iundusi, Elena Gasbarra
Osteoporosis and sarcopenia: the connections
Aging Clinical and Experimental Research 2013
Abstract
Osteoporosis and sarcopenia are the most frequent musculoskeletal disorders affecting older people. Osteoporosis is a widespread disorder affecting millions of individuals of all ethnic backgrounds worldwide, particularly among older women. It is characterized by reduced bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in the risk of fracture. Sarcopenia is considered to be one of the major factors responsible for functional limitations and motor dependency in elderly persons. In age-related muscle atrophy, a decrease in muscle fiber size and number, and a preferential loss of type II fibers have been reported. A decrease in the circulating levels of specific hormones (e.g., estrogen, testosterone, growth hormone, and insulin-like growth factor-1) has been shown to be associated with sarcopenia and this appears to play an important role in its pathogenesis.
Guido Zarattini
Osteosynthesis and hip replacement in proximal femur fractures
Aging Clinical and Experimental Research 2013
Abstract
Proximal femur fractures are common in elderly osteoporotic patients. The consequences of hip fractures in elderly individuals are significant in terms of years of life lost and reduction of the quality of life. The goal of the treatment is to return the patients to their pre-fracture level of quality of life and avoid complications during the surgery. To achieve this goal, surgery is usually required for the vast majority of hip fracture patients. The proximal femur fractures are classified into medial and lateral fractures; usually the former fractures are treated with hip replacement and the latter are treated with osteosynthesis. The best way to treat this type of injury is mandatory and requires an accurate pre-operative classification of the lesion, considering also the comorbidity associated with the hip fractures.
Umberto Tarantino, Monica Celi, Maurizio Feola, Federico Maria Liuni, Giuseppina Resmini, Giovanni Iolascon
A new antiresorptive approach to the treatment of fragility fractures: long-term efficacy and safety of denosumab
Aging Clinical and Experimental Research 2013
Abstract
An imbalance of the remodeling process for bone resorption leads to a loss of tissue with consequent microarchitectural damage, evident in conditions such as osteoporosis and related fragility fractures. Currently, pharmacological therapies are able to prevent or slow down bone resorption by inhibiting osteoclast activity. An innovative and targeted anti-resorptive approach is represented by the inhibition of RANK ligand (RANK-L), essential for the proliferation and activity of osteoclastic cells. The human monoclonal antibody against RANK-L (denosumab) has been approved for the treatment of osteoporosis. In clinical trials of patients with osteoporosis, inhibition of RANK-L has reduced bone loss and damage to the microarchitecture and was associated with an increase in mass and resistance at different skeletal sites, with most significant effects than those demonstrated by any other antiresorptive drugs. In addition, after 3 years of treatment, it showed a reduction in vertebral and non-vertebral fracture risk. Denosumab treatment also has not revealed any alteration in the physiological processes of fracture repair, showing no increase in the onset of complications 3 years after the fracture. The data show that denosumab offers an effective alternative therapeutic approach for the treatment of severe osteoporosis, with positive effects on BMD and reduction of fragility fractures risk. So, promising results in terms of therapeutic efficacy and reliability make desirable the wide clinical use of denosumab for the treatment of osteoporotic fractures in the near future.